Objective Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described.Methods The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered.Results IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43 000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols.Conclusion IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia.What is known about this topic? The high rates of respiratory illnesses in Australian Indigenous children have been poorly explored. There is a dearth of research quantifying and qualifying risk from birth and throughout early childhood, and there are virtually no evidence-based evaluations of interventions to prevent and manage disease. Despite data suggesting an excess burden of disease, there has been little attention paid to respiratory health in this population. The limited research that has been done highlights that a ‘one size fits all’ model will not be effective in all communities, and that health service must meet the needs of communities, be culturally appropriate and be accessible to Aboriginal people for it to be effective and sustainable. The ‘common theme’ is that although health services are improving, service delivery needs to adapt to meet the needs of communities; this is not happening quickly enough for many Aboriginal people.What does this paper add? This paper highlights the importance of working with communities in the development and delivery of a culturally appropriate and accessible specialist respiratory service. In addition, this paper acknowledges the importance of recruiting Indigenous staff in the implementation, engagement and delivery of the project.What are the implications for clinicians? This paper provides an outline on how best to deliver a culturally appropriate respiratory outreach service and the role of clinicians, communities and Indigenous staff. This model supports the view that Aboriginal people must be a part of service delivery that is aligned to the ‘holistic concept of health’ for Aboriginal people, thus providing a culturally appropriate service that meets their needs and addresses the health continuum from within culture and community.